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<br />813-780-0020
<br />
<br />
<br />Owner Phone Number
<br />
<br />Owner Phone Number I
<br />
<br />Owner Phone Number I
<br />
<br />Date Received
<br />
<br />JOB ADDRESS
<br />
<br />ow~er's Name VI IOY"&t(JL..
<br />
<br />Own." AddN" I W/?c, I!"" Sf: I ~tzMh, R,dJifk
<br />
<br />Fee Simple Titleholder NamelJavnfl;:; #l __ ~
<br />
<br />Fee Simple Titleholder Address I 5a..m.e.- a ~ ti.-hor(l ~
<br />
<br />~/3~ /q-Hc5l; hp~rlJll4 If- 3.3W- I LOU I~I
<br />I PARCEL ID# I(~ - ;;{6--~/- cJ J q {j.-{)L)d O()-6;L/ 0
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />D SIGN D MOVE D
<br />
<br />D
<br />D
<br />
<br />SUBDIVISION
<br />
<br />BUILDING SIZE
<br />
<br />
<br />NEW CONSTR
<br />INSTALL
<br />SFR
<br />BLOCK
<br />
<br />~
<br />o
<br />o
<br />/).) /h d{)W enfr.
<br />
<br />ADD/ALT
<br />REPAIR
<br />COMM
<br />FRAME
<br />
<br />DEMOLISH
<br />
<br />WORK PROPOSED
<br />
<br />PROPOSED USE
<br />TYPE OF CONSTRUCTION
<br />
<br />OTHER
<br />STEEL
<br />
<br />I
<br />D
<br />
<br />OTHER I ;Cj-LOJ1.1-tA/O m
<br />
<br />SQ FOOTAGE
<br />
<br />
<br />HEIGHT
<br />
<br />~
<br />
<br />1$ /000 C32- I
<br />
<br />D ELECTRICAL 1$ I AMP SERVICE ~ PROGRESS ,ERGY D W.R.E.C
<br />
<br />D PLUMBING 1$ I bifu b;, ~ ~~
<br />
<br />D MECHANICAL 1$ I VALUATION OF MECHANICALlNSTAllATION~~,L.
<br />
<br />D GAS D ROOFING 0 SPECIALTY D OTHER
<br />FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES ~NO
<br />
<br />I11111111111111111111111111111111111111111111111111111IIIIIIIIIIIIIIIIIII~IIIIIIII;IIIIIIIIIIIIIIIIIIIIIIIII1111111111111111111111111111111111
<br />
<br />:~~~~~RE I COMPANY I ~t 1!c~!Il~ I I
<br />
<br />License # I t1:..yoo5Z/79
<br />
<br />BUILDING
<br />
<br />VALUATION OF TOTAL CONSTRUCTION
<br />
<br />Address
<br />
<br />
<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<br /> License #
<br />Y/ N FEE CURRENT
<br /> License #
<br />Y/N FEE CURRENT
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />Address
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />Y/N
<br />
<br />License #
<br />111111111111111111111111111111111111111111111I11111111111I111111111111111111111111111111111111111111111111111111111111111111111111
<br />Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction,
<br />Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
<br />Attach (3) sets of Building Plans; (1) set of Energy Forms. R-O-W Permit for new construction.
<br />Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
<br />Attach (2) sets of Engineered Plans,
<br />....PROPERTY SURVEY required for all NEW construction.
<br />
<br />DI~~~ti~~~':' . , , , , , . , , , , . . , . . , . , . . . . , , . . . . . . . . . , , , . . , , , . . , , , . . , , , . . , . , . . . . . , , , . . , , , . . , , , . . . . , , . . . . , , , . . . . . . . . , , , , , . . . . , , , , , . . . . . , . . , , . , , . , . . , . . . , . ,
<br />
<br />Fill out application completely.
<br />Owner & Contractor sign back of application, notarized
<br />If over $2500. a Notice of Commencement is required. (AlC upgrades over $5000)
<br />
<br />Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
<br />
<br />OVER THE COUNTER PERMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades AlC Fences (Plot/Survey/Footage)
<br />
<br />Address
<br />111111111111111
<br />RESIDENTIAL
<br />
<br />COMMERCIAL
<br />
<br />SIGN PERMIT
<br />
<br />Driveways-Not over Counter if on public roadways..needs ROW
<br />
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